Until the process is complete, you ... - Kansas Board of EMS

Landon State Office Building 900 SW Jackson Street, Room 1031 Topeka, KS 66612-1228

Dr. Joel E Hornung, Chair Joseph House, Executive Director

Board of Emergency Medical Services

phone: 785-296-7296 fax: 785-296-6212

Laura Kelly, Governor

Reinstatement Information Packet

The process for reinstating an expired certification does not constitute an extension of certification. Until the process is complete, you may not legally practice as an EMS Provider in the State of Kansas.

Continuing education or initial course requirements described in K.A.R. 10915-1 (available at , under Legal, then Regulations) will need to be completed in order for you to have your EMS provider certification reinstated.

If you are reinstating within 31 days of your certification expiration the following fees apply per K.A.R. 109-7-1:

EMR: $40.00 EMT: $60.00 AEMT: $60.00 Paramedic: $100.00

If you are reinstating past 31 days of your certification expiration the following fees apply per K.A.R. 109-7-1:

EMR: $80.00 EMT: $120.00 AEMT: $120.00 Paramedic: $200.00

If you have any questions, please email Chrystine at chrystine.hannon@.

Application to Re-Instate an Expired Certification

Kansas Board of EMS, 900 SW Jackson Street, Rm. 1031, Topeka, KS 66612 785-296-7296

Your social security number is required pursuant to 42 U.S.C.S. ?666(a)(13), K.S.A. 74-148

and K.S.A. 74-139, and may be used for child support purposes or provided to the Kansas

Director of Taxation, upon request.

TYPE OR PRINT CLEARLY

SS#:

Certification Level:

First Name:

Middle:

Last:

Street:

Previous Name:

City:

State:

Zip:

County:

Work Phone:

Home Phone:

Education: Please check highest grade completed.

HS/GED Some College Associate Bachelor Masters Doctorate

1. Do you provide EMS services to your community and/or business/industry? Answer yes or no. If you answered No, skip to Question 4

2. If you answered Yes on Question 1, with what type of service are you involved? Answer 1 for Ambulance service, 2 for Organized first response unit or 3 for other

3. If you answered Yes on Question 1,

(a) Who operates your organization?

3a.

1 = Hospital

2 = Fire department

3 = Law enforcement

4 = Government (non-fire) 5 = Private (non-hospital) 6 = Business/Industry

(b) What is your current level of EMS involvement?

3b.

1 = Full time 2 = Part time 3 = Volunteer

(c) Please indicate method of compensation. Answer "Y" for Yes and "N" for No for each response.

No pay

Call time Per call

Hourly rate

Salary

Complete the entire form. Attach copies of your certificates of attendance. Enclose the appropriate fee and sign the form. Make check payable to the Kansas Board of EMS. This fee is non-refundable.

(Continued on back)

Have you ever been convicted of a felony?

Yes______ No______

Are criminal proceedings, either felony or misdemeanor pending in any federal, state or municipal court?

Yes______ No______

Is an investigation and/or disciplinary action pending against any license, certification or registration?

Yes______ No______

Has any license, certification or registration ever been denied, revoked, suspended, limited or disciplinary action taken by a licensing authority of any state, agency of the US government, territory of the US or country?

Yes______ No______

Are you currently on or are you required to register on any state offender registry as part of any criminal

sentencing?

Yes______ No______

This application is true and complete to the best of my knowledge.

Signature of Applicant

Date

Revised 01/16 page 3

109-15-1. Reinstating attendant certificate after expiration. (a) The certificate of a person who applies for attendant certification after the person's certificate has expired may be reinstated by the board if the person meets the following requirements:

(1) Submits a completed application to the board on forms provided by the executive director;

(2) pays the applicable fee specified in K.A.R. 109-7-1; (3) provides validation of completed education requirements; and (4) if the applicant is either currently certified or licensed in another jurisdiction or has been certified or licensed in another jurisdiction, provides information adequate for the board to determine the applicant's current status of certification or licensure for the level of certification being sought and confirm that the applicant is in good standing with that jurisdiction. (b) For the purposes of this regulation, the date of expiration for the certificate shall be one of the following: (1) The expiration date of the person's Kansas attendant certificate; (2) 31 calendar days after the expiration date of the person's certificate or license, if the person is currently certified or licensed in another jurisdiction; or (3) the most recent expiration date of the person's certificate or license in another jurisdiction, if the person is not currently certified or licensed in another jurisdiction but previously held a certificate or license in that jurisdiction.

K.A.R. 109-15-1 Page 2

(c) Completion of education requirements shall be validated by submission of the following:

(1) Documentation of continuing education for the three years before the date of application in sufficient quantity to meet or exceed the following:

(A) For applications submitted within 31 calendar days from the date of expiration, the number of clock-hours specified for renewal of a certificate in K.A.R. 1095-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic;

(B) for applications submitted more than 31 calendar days but less than two years from the date of expiration, two times the number of clock-hours specified for renewal of a certificate in K.A.R. 109-5-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic;

(C) for applications submitted two or more years but less than four years from the date of expiration, three times the number of clock-hours specified for renewal of a certificate in K.A.R. 109-5-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic;

(D) for applications submitted four or more years but less than six years from the date of expiration, four times the number of clock-hours specified for renewal of a certificate in K.A.R. 109-5-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic;

K.A.R. 109-15-1 Page 3

(E) for applications submitted six or more years but less than eight years from the date of expiration, five times the number of clock-hours specified for renewal of a certificate in K.A.R. 109-5-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic; and

(F) for applications submitted eight or more years from the date of expiration, six times the number of clock-hours specified for renewal of a certificate in K.A.R. 109-5-1a for EMR, K.A.R. 109-5-1b for EMT, K.A.R. 109-5-1c for AEMT, or K.A.R. 109-5-1d for paramedic;

(2) for applications submitted two or more years from the date of expiration, validation of cognitive and psychomotor competency by the following:

(A) Successful completion of a cognitive assessment for the level of certification being sought, within three attempts;

(B) successful completion of a psychomotor assessment for the level of certification being sought, within three attempts; and

(3) for applications submitted two or more years from the date of expiration, documentation of successful completion of a cardiopulmonary resuscitation course for healthcare providers.

(d) Each person who applies for reinstatement of certification two or more years after the date of expiration shall take an entire initial course of if the person is unable to provide validation of cognitive or psychomotor competency by one of the following, whichever occurs first:

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